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Glaucoma Treatment Guidelines

SLT is a relatively quick and easy outpatient procedure. During treatment, approximately 50 confluent spots are placed along the meshwork to treat a 180-degree angle. The following treatment guidelines have been prepared by Ellex’s SLT Clinical Advisory Network and provide guidance for physicians who are new to the SLT technique; however, it is the operating physician’s responsibility to familiarize themselves with the latest recommended techniques.

Patient Selection

SLT is well suited to most patients with abnormally elevated IOP, who may benefit from IOP reduction. Patients with any type of adult glaucoma, and those who conform to the following criteria, are suitable candidates:

Require lowering of IOP as either primary or secondary therapy

Unlikely to comply and/or persist with drug therapy

Have difficulty administering eye drops

Suffer from drug therapy induced side effects

Complain of reduced quality of life due to the need to administer eye drops daily

Failed drug therapy

Failed ALT treatment, or if ALT ceased to reduce the IOP sufficiently

Failed SLT treatment, or if SLT ceased to reduce the IOP sufficiently

Pigmentary or pseudoexfoliation glaucoma (Proceed with caution as there is a risk of post-SLT IOP spike)

Normal tension glaucoma

Ocular hypertension

Energy Level

To determine the optimal level of energy for each patient, the SLT laser is initially set at 0.8 mJ (in cases of heavily pigmented trabecular meshwork), set the energy at 0.4 mJ) and the energy level increased in 0.1 mJ steps until the threshold energy level for mini-bubble formation (micro cavitations) is observed, or decreased in 0.1 mJ steps if bubble formation was noted. After the threshold level is found (when mini-bubble formation occurs) the energy level is decreased in 0.1 mJs steps as treatment continues until bubble formation ceases. This energy is then used for treatment. Note that some users aim to treat with minimal fine bubble formation with each application.The process should be monitored and adjusted as necessary as pigment variation alters energy uptake at a lower threshold. Generally, the trabecular meshwork is more heavily pigmented inferiorly than superiorly.

Post-Treatment

Apply a nOn-steroidal anti-inflammatory drop such as Ketorolac or Acular drops four times daily for three to five days.